Background: Fungal infections are gaining prominence in recent years and are becoming a cause of significant morbidity as well as mortality. Reliable data from India about the spectrum of pathogens causing fungal infection in various body systems, and particularly about the antifungal susceptibility pattern of Candida spp., which is the most common isolate worldwide is not available.
Methods: We prospectively studied 48,155 clinical samples submitted for fungal work-up to the microbiology laboratory at our tertiary care teaching hospital. Standard procedures were followed for fungal identification. Candida isolates were differentiated into Candida albicans and non-albicans candida (NAC) by germ tube test. Antifungal susceptibility of Candida isolates was determined by disc diffusion technique using amphotericin B (10 μg), fluconazole (25 μg), and voriconazole (1 μg) discs.
Results: A total of 555 fungal isolates were obtained of which 541 were Candida spp, while the others were filamentous fungi. Male gender and age over 50 years were found to be independent risk factors. Proportion of NAC isolates (n =384, 69.2%) were greater compared to C. albicans (n = 157, 28.3%). Aspergillus spp. was the second most frequent isolate. Azole resistance was significantly more in NAC group as compared to C. albicans. For fluconazole, 57.5% of the NAC showed resistance compared to 24.8% seen in strains of C. albicans while the corresponding figure for voriconazole was 56.8% Vs 22.9%. Overall resistance for amphotericin B was low (8.9%).
Conclusions: Our observations bring to light the spectrum of common fungal isolates and their susceptibility patterns. This information will be useful for health planners and policy makers, as early institution of appropriate antifungal treatment can be life saving.

MicroRNAs (miRNAs) are a class of endogenous small non-coding RNAs about 21-25 nucleotides in length and account for 1%-5% of the genome. Ever since its discovery in 1993, these molecules have attracted researchers due to their crucial role in regulating gene expression. Dysregulation in miRNA expression profile could serve as molecular signatures for identifying diseases. These have found applications in a number of diseases including cancer, wherein they may be useful for as biomarkers in cancer diagnosis as well as serve as therapeutic targets. This review provides an update on the evolution of miRNAs in the field of medicine and its future therapeutic applications.

Takayasu’s arteritis is a chronic inflammatory large vessel vasculitis of unknown aetiology that commonly affects women of child bearing age. It appears to have an acute early phase, with non- specific symptoms such as hypertension, headache, fever, muscle pain, arthralgia, night sweats and weight loss. Stroke, as presenting feature of Takayasu’s arteritis is rare. Our patient presented with brocas aphasia, right hemiplegia and right-sided facial palsy. Physical examination revealed left-sided carotid bruit and absent peripheral pulses. CT angiography showed to have right subclavian, left internal carotid and middle cerebral arteritis. She was treated with immunosuppressive treatment and showed significant improvement. Though subclavian artery involvement is not rare, presentation with stroke is rare.1 Takayasu’s arteritis must be considered as a cause of stroke in young women.

Metformin-associated lactic acidosis (MALA) in the absence of other risk factors, is extremely rare. A 60-year-old male presented to the emergency department feeling tired and breathless for the preceeding 3 days. He had a 10 year history of type 2 diabetes mellitus (T2DM) and was receiving treatment with metformin. There was no history of fever, cough or orthopnoea. Physical examination was unremarkable. Arterial blood gas analysis showed an increased anion gap metabolic acidosis and raised lactate. Mild pre-renal impairment was also present. There was no evidence of sepsis, heart or liver failure, anaemia or history of alcohol abuse. He received intravenous fluids with resultant normalisation of renal function but lactate levels remained elevated and bicarbonate remained low. At this point a diagnosis of MALA was considered. Metformin was stopped and within 24 hours lactate and bicarbonate levels returned to normal limits. This case highlights the possibility of metformin-treated patients developing lactic acidosis in the absence of other risk factors. Any unwell patient taking metformin should undergo measurement of serum lactate and bicarbonate.

Hepatoid adenocarcinoma is a rare histological form of gastric cancer with a poor prognosis. We describe a 53-year-old woman who presented to the surgical gastroenterology outpatient department with a history of abdominal pain, vomiting and loss of appetite for one month. Laboratory investigations revealed anaemia (haemoglobin 5.6 g/dL). On gastrointestinal endoscopy, an ulceroproliferative growth was seen in the pylorus with gastric outlet obstruction. Endoscopic biopsy was suggestive of a well differentiated adenocarcinoma. Computed tomography of abdomen revealedirregular circumferential thickening of pylorus with perigastric and common hepatic nodes without distant metastasis. Patient underwent radical subtotal gastrectomy. The final histopathology was reported as hepatoid adenocarcinoma. Further immunohistochemistry with alpha-foetoprotein showed intense cytoplasmic positivity. She was treated with adjuvant Macdonald regimen. She developed liver metastasis eight months after surgery and received palliative chemotherapy. She died 13 months after surgery. Our experience and previous reports suggest that hepatoid adenocarcinoma is an aggressive cancer. Radical surgery and chemotherapy still remain the main stay of treatment.

Jarcho-Levin syndrome (JLS) is a rare heterogeneous disorder characterised by short neck, short trunk and multiple vertebral and rib anomalies. Sprengel shoulder deformity is elevation of shoulder joint due to upward displacement of scapula. We are reporting a case of Jarcho-Levin syndrome associated with Sprengel deformity.

Background: The Society of Radiologists in Ultrasound (SRU) recommendations on thyroid nodules are intended to ”diagnose thyroid cancers that have reached clinical significance,while avoiding unnecessary tests and surgery in patients with benign nodules.”
Methods: This prospective observational study was conducted on 193 consecutive patients undergoing ultrasonography (USG) guided thyroid FNA. Nodules were categorized as “SRU-positive”and “SRU-negative” based on USG features. The sensitivity and specificity of the SRU recommendations and of various US features for thyroid malignancy were calculated.
Results: Of 193 patients subjected to FNA, 83 patients of Bethesda class I, III, IV, V were excluded. Among 110 nodules subjected to FNA, 79 were SRU positive and 31 were SRU negative. There were 24 malignancies in 110 FNA (22% malignancy prevelance). There was significant difference between the malignancy rates of SRU positive and negative groups (p=0.0192). The sensitivity, specificity, PPV, NPV of thyroid malignancy in our cohort was 91.6%,33.7%, 27.8% and 93.5% respectively.
Conclusions: The application of SRU recommendations reduces the number of benign nodules that undergo workup. Potentially missed malignancies in SRU negative nodules are less aggressive by histologic type and stage compared to SRU-positive malignancies.

Background: The present study aim was designed to compare and evaluate the efficacy of adding two different doses of magnesium sulphate to 0.5% hyperbaric levobupivacaine for spinal anaesthesia in terms of block characteristics, haemodynamic and safety profile.
Methods: Ninety American Society of Anaesthesiologist (ASA) grade I–II patients undergoing elective infra-umbilical surgeries under spinal anaesthesia were randomly allocated into three groups. Group C (n=30, control group) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine; Group M50 (n=30): received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 50 mg of magnesium sulphate. Group M100 (n=30) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 100 mg of magnesium sulphate. A standard protocol was followed after which a blinded observer assessed the sensory and motor blocks. The onset and duration of sensory (pin-prick) block, onset, intensity and duration of motor block were recorded.
Results: All the subarachnoid blocks were adequate. The addition of magnesium sulphate to intrathecal levobupivacaine had not only increased the time to onset of sensory block (p=0.007) but also prolonged the duration of sensory (p<0.001) and motor block (p<0.001) to statistically significant level in a dose dependent manner.
Conclusions: Addition of magnesium sulphate does not offer any further advantage in terms of haemodynamic stability. However, it certainly increases the duration of sensory block to a significant level.